Provider Demographics
NPI:1366854226
Name:HOLMGREN, BRYCE COLE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:COLE
Last Name:HOLMGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:166 19TH ST S STE 101
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2154
Mailing Address - Country:US
Mailing Address - Phone:320-230-7788
Mailing Address - Fax:320-230-7789
Practice Address - Street 1:166 19TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2154
Practice Address - Country:US
Practice Address - Phone:320-230-7788
Practice Address - Fax:320-230-7789
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN66143207L00000X
KS9408317207L00000X
CAA153895207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology